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Nikai K, Koga H, Suda K, Miyahara K, Lane GJ, Arakawa A, Fukumura Y, Saiura A, Hayashi Y, Nagakawa Y, Okazaki T, Takishita C, Yanai T, Yamataka A. Prospective evaluation of common hepatic duct histopathology at the time of choledochal cyst excision ranging from children to adults. Pediatr Surg Int 2023; 40:15. [PMID: 38032513 DOI: 10.1007/s00383-023-05589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To evaluate common hepatic duct just distal to the HE anastomosis (d-CHD) prospectively for mucosal damage, inflammation, fibrosis, dysplasia, carcinoma in situ, malignant transformation, effects of serum amylase, and symptoms at presentation in CC cases ranging from children to adults. METHODS Cross-sections of d-CHD obtained at cyst excision 2018-2023 from 65 CC patients; 40 children (< 15 years old), 25 adults (≥ 15) were examined with hematoxylin and eosin, Ki-67, S100P, IMP3, p53, and Masson's trichrome to determine an inflammation score (IS), fibrosis score (FS), and damaged mucosa rate (DMR; damaged mucosa expressed as a percentage of the internal circumference). RESULTS Mean age at cyst excision ("age") was 18.2 years (range: 3 months-74 years). Significant inverse correlations were found for age and DMR (p = 0.002), age and IS (p = 0.011), and age and Ki-67 (p = 0.01). FS did not correlate with age (p = 0.32) despite significantly increased IS in children. Dysplasia was identified in a 4-month-old girl with cystic CC. Serum amylase was elevated in high DMR subjects. CONCLUSIONS High DMR, high IS, and evidence of dysplasia in pediatric CC suggest children are at risk for serious sequelae best managed by precise histopathology, protocolized follow-up, and awareness that premalignant histopathology can arise in infancy.
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Affiliation(s)
- Koki Nikai
- Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kazuto Suda
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Miyahara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yutaka Hayashi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan
| | - Chie Takishita
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
- Department of Surgery, Toda Chuo General Hospital, Saitama, Japan
| | - Toshihiro Yanai
- Department of Pediatric Surgery, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Beltrán MA, Beltrán AA. Common bile duct pressure in patients with and without cholelithiasis: A case-control study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:443-449. [PMID: 33636035 DOI: 10.1002/jhbp.931] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. METHODS A prospective case-control study was designed. The study universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II over 30 months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis. RESULTS Common bile duct pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p < 0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (P < 0.0001). CONCLUSIONS Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.
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Affiliation(s)
- Marcelo A Beltrán
- Department of Surgery, Hospital San Juan de Dios de La Serena, Coquimbo, Chile
| | - Andrea A Beltrán
- Medicine School, Universidad de Santiago de Chile, Santiago, Chile
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Iwasaki T, Otsuka Y, Miyata Y, Einama T, Tsujimoto H, Ueno H, Ogata S, Kishi Y. Intracholecystic papillary neoplasm arising in a patient with pancreaticobiliary maljunction: a case report. World J Surg Oncol 2020; 18:292. [PMID: 33168026 PMCID: PMC7654008 DOI: 10.1186/s12957-020-02072-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumorigenesis of ICPNs remains unclear. Case presentation A 52-year-old Japanese woman was referred for the assessment of dilation of the bile duct. Computed tomography which revealed an enhanced mass in the gallbladder and endoscopic retrograde cholangiopancreatography confirmed that the confluence of the main pancreatic duct and extrahepatic bile duct (EHBD) was located outside the duodenal wall. Under the diagnosis of gallbladder cancer with PBM, cholecystectomy with full thickness dissection, EHBD resection, lymph node dissection, and hepaticojejunostomy were performed. Macroscopic examination of the resected specimen showed that the cystic duct was dilated and joined into the EHBD just above its confluence with the pancreatic duct, and the inflamed change of non-tumorous mucosa of gallbladder indicating that there was considerable mucosal injury due to pancreatobiliary reflux to the gallbladder. Histopathological examination revealed that the gallbladder tumor was a gastric-type ICPN with non-invasive component. Either KRAS gene mutation or p53 protein expression that were known to be associated with the carcinogenesis of biliary cancer under the condition of pancreatobiliary reflux was not detected in the tumor cells of ICPN. Conclusion The present case might suggest that there was no association between PBM and ICPN. To reveal the tumorigenesis of ICPN and its attribution to pancreatobiliary reflux, however, further study is warranted.
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Affiliation(s)
- Toshimitsu Iwasaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Yasuhiro Otsuka
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoichi Miyata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takahiro Einama
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Sho Ogata
- Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Zhang C, Zhou J, Kou K, Liu S, We F, Wang G. Occurrence of signet-ring cell carcinoma with cholangiocarcinoma 25 years after choledochal cyst excision: A case report. Medicine (Baltimore) 2018; 97:e9956. [PMID: 29465585 PMCID: PMC5841982 DOI: 10.1097/md.0000000000009956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Choledochal cysts are a risk factor for the development of cholangiocarcinoma. Hence, complete surgical excision is the preferred treatment in most cases. However, cholangiocarcinoma still can develop from the remnant biliary system after surgical excision. Signet-ring cell carcinoma is a rare type of cancer of the biliary system, and the occurrence of signet-ring cell carcinoma after surgical excision of choledochal cysts has not been reported in the English literature to date. PATIENT CONCERNS We report a case of a 32-year-old woman who presented with a 1-month history of abdominal pain,obstructive jaundice, itching, and fever. The patient had undergone choledochal cyst excision and Roux-en-Y hepatico-jejunostomy 25 years previously and had now developed signet-ring cell carcinoma along with cholangiocarcinoma at the anastomotic site. DIAGNOSES:: signet-ring cell carcinoma along with cholangiocarcinoma. INTERVENTIONS Interventions included laparotomy with evacuation,blood transfusion,and other adjuvant therapy. OUTCOMES The patient died five months later. LESSONS Surgery is the best treatment for CCCs, and the surgeon should try to remove as much as of the bile duct cyst as possible.
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Rajekar H. Synchronous Gall Bladder and Bile Duct Cancer: A Short Series of Seven Cases and a Brief Review of Literature. J Clin Exp Hepatol 2017; 7:115-120. [PMID: 28663675 PMCID: PMC5478970 DOI: 10.1016/j.jceh.2016.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/21/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Simultaneous presence of cancer in the gall bladder and in the biliary tree could be due to local spread, metastases, de novo multifocal origin, or as part of a field change. In the past, such an association has been described in patients with anomalous pancreatico-biliary ductal junction. AIMS We studied seven consecutive patients with simultaneous gall bladder and bile duct malignancy with a view to identify the best way to treat them, and if possible to hypothesize the etiopathogenesis. METHODS Over a period of 24 months, there were seven cases, with synchronous gall bladder and extra-hepatic bile duct cancer. RESULTS None of our patients had anomalous pancreatico-biliary ductal junction. Three patients were found to have inoperable disease, three other underwent curative resection, and one patient had a complete response to chemotherapy. Herein, we describe these patients and our lessons learnt from these patients with synchronous bile duct and gall bladder cancer. Of the seven patients, we were able to complete a curative resection in three patients, and the three patients were found to have inoperable disease. One patient had an excellent response to chemotherapy. CONCLUSION Thus aggressive therapy in such patients with gall bladder cancer may be warranted in select cases. Also, the gall bladder specimens in patients undergoing surgery for cholangiocarcinoma should be analyzed in detail to identify foci of dysplasia or change in the epithelium. The pathogenesis may be due to a common field change in the biliary epithelium.
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Affiliation(s)
- Harshal Rajekar
- Address for correspondence: Dr. Harshal Rajekar, Consultant Hepatobiliary and Transplant Surgeon, Centre for Liver and Pancreatic Diseases, Ruby Hall Clinic, 1st Floor, Cancer Building, 40, Sassoon Road, Pune 411001, India.Centre for Liver and Pancreatic Diseases, Ruby Hall Clinic1st Floor, Cancer Building, 40, Sassoon RoadPune411001India
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La Pergola E, Zen Y, Davenport M. Congenital choledochal malformation: search for a marker of epithelial instability. J Pediatr Surg 2016; 51:1445-9. [PMID: 27114310 DOI: 10.1016/j.jpedsurg.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/09/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE There is a predisposition to the development of malignancy in congenital choledochal malformation (CCM) although the degree of risk is unknown. We investigated the role of CA19-9 in bile and the MIB-1 (Ki-67) epithelial proliferation index as markers of an at risk choledochal epithelium at the time of definitive surgery. METHODS Bile collected at surgery was analyzed for levels of amylase (as a surrogate of pancreatic reflux) and CA19-9. Immunohistochemical staining for CA19-9 and MIB-1 index (expressed as %) was performed on resected specimens. Data are quoted as median (IQR) and differences assessed using non-parametric statistics. A P value of 0.05 was regarded as significant. RESULTS Our study group consisted of 78 children with CCM (Type 1 fusiform, n=34; Type 1 cystic, n=30 and Type 4, n=14). Median bile CA19-9 was 159,400 (6-1×10(6)) kU/L. There was no correlation with bile amylase (P=0.49) or biliary pressure (P=0.17) but modest correlation with bilirubin (rs=0.24; P=0.02). In contrast, bile amylase was correlated with plasma γ-glutamyl transpeptidase (P=0.02), alkaline phosphatase (P=0.05) and aspartate aminotransferase (P=0.02); and inversely correlated with biliary pressure (rs=-0.38; P<0.0008). Epithelial expression of CA19-9 and MIB-1 was assessed in 43 specimens. CA19-9 was diffusely expressed on all choledochal epithelium. MIB-1 expression was divided into: high expression (>40%) n=3; moderate (20-40%) n=5, low (6-20%) n=7 and very low (≤5%) n=28. There was no correlation with choledochal pressure (P=0.87), CA19-9 (P=0.51) or bile amylase (P=0.55). CONCLUSION Biliary CA19-9 levels were grossly (and unexpectedly) raised in choledochal malformation and appear to arise from biliary rather than pancreatic epithelium. MIB-1 confirms that a small proportion (19%) has marked epithelial proliferation but no clinical correlates could be identified.
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Affiliation(s)
- Enrico La Pergola
- Department of Paediatric Surgery, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan)
| | - Yoh Zen
- Institute of Liver Studies, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan)
| | - Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, London, UK (now, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan).
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Michalinos A, Alexandrou P, Papalambros A, Oikonomou D, Sakellariou S, Baliou E, Alexandrou A, Schizas D, Felekouras E. Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst: a link between choledochal cyst and gallbladder cancer? World J Surg Oncol 2016; 14:202. [PMID: 27480698 PMCID: PMC4969726 DOI: 10.1186/s12957-016-0962-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intracholecystic papillary-tubular neoplasms are rare precursor lesions of gallbladder cancer. They were proposed as a separate pathologic entity in 2012 by Adsay et al. for the unification of a variety of mass-forming precursor lesions including papillary adenomas, tubulopapillary adenomas, intestinal adenomas, and others. They are considered homologous to intrapapillary mucinous neoplasms of the pancreas and intrabiliary papillary neoplasms of the common bile duct. In contrast with the commoner flat-type precursor gallbladder cancer lesions, they follow a more indolent clinical course and probably different genetic pathways to carcinogenesis. They are largely uninvestigated with only a handful of studies providing biological and clinical information. Choledochal cysts are dilation of the common bile duct. Diagnosis is usually established during childhood, and only a minority of patients are diagnosed at adulthood. They are of major clinical importance as they are known predisposing factors for biliary carcinogenesis. CASE PRESENTATION The current report describes a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. The patient underwent excision of the extrahepatic biliary tree for a Todani I choledochal cyst, and histological examination of the specimen revealed an intracholecystic papillary-tubular neoplasm of the gallbladder. Authors describe diagnostic and clinical course of the patient alongside clinical and biological characteristics of these rare lesions. CONCLUSIONS To the best of our knowledge, this is the first report of a patient with a simultaneous diagnosis of choledochal cyst and intracholecystic papillary-tubular neoplasm. Those rare lesions shed light on different forms of gallbladder cancer carcinogenesis and its relationship with choledochal cysts and cholestasis.
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Affiliation(s)
- Adamantios Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece.
| | - Parakevi Alexandrou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Papalambros
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Dimitrios Oikonomou
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Baliou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, Greece
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Resende V, Santos JPLDS, Gomes RV, Vidigal PVT, Pedrosa MS. Papillary neoplasias of the biliary tract. Rev Col Bras Cir 2015; 41:445-50. [PMID: 25742412 DOI: 10.1590/0100-69912014006011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/20/2014] [Indexed: 12/13/2022] Open
Abstract
The authors conducted a revisional study of intraepithelial papillary lesions of the bile ducts, characterized by being a kind of rare, intraductal growing cholangiocarcinoma. Articles published in the last 10 years were reviewed. The authors considered that the adenoma-carcinoma development is an important feature to warrant prophylactic measures through excisions. The histological type and biomolecular behavior may have relevance in the postoperative course of such lesions, which have a better prognosis when compared with other histological types.
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Affiliation(s)
- Vivian Resende
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais State, Brazil
| | | | - Rodrigo Vieira Gomes
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais State, Brazil
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Chen F, Tang L, Zhang ZQ, Jin BW, Dong WF, Wang J, Huang SG. Liver, biliary and pancreatic injuries in pancreaticobiliary maljunction model in cats. Hepatobiliary Pancreat Dis Int 2015; 14:90-5. [PMID: 25655296 DOI: 10.1016/s1499-3872(14)60306-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreaticobiliary maljunction is a high risk factor of pancreatitis and biliary tract cancer. How this maljunction affects the liver remains obscure. This study aimed to examine the effects of pancreaticobiliary maljunction on the liver, pancreas and gallbladder in a cat model. METHODS A model of choledocho-pancreatic side-to-side ductal anastomosis was created in ten cats. Before the procedure, a small piece of tissue from the liver, pancreas and gallbladder was collected as a control. The common channel formation was checked by cholecystography. The livers, pancreases and gallbladders of these cats were harvested for histological examination. The expression of proliferating cell nuclear antigen in the gallbladder was examined with immunohistochemistry. RESULTS Seven of the 10 cats survived for 6 months after surgery. The color of the liver was darker in the PBM model than the control specimen, with nodules on the surface. Histological examination showed ballooning changes and inflammatory infiltrations and the histopathological score increased significantly (P<0.05). Also, mitochondria swelling and lipid droplet in cytoplasm were observed under an electron microscope. The pancreas also appeared darker in the PBM model than the control specimen and dilated pancreatic ducts were found in three cats. Histopathological examination revealed vascular proliferation and inflammatory infiltration with numerous neutrophils. Gallbladder epithelial cells were featured by expanded endoplasmic reticulum, increased intercellular space and cellular nucleus deformation. The positive cells of proliferating cell nuclear antigen were increased significantly (P<0.05). CONCLUSION The present study demonstrated that pancreaticobiliary maljunction can lead to the injuries of the liver, pancreas and gallbladder.
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Affiliation(s)
- Feng Chen
- Division of General Surgery, Soochow University Affiliated Children's Hospital, Suzhou 215003, China.
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Kim DH, Choi DW, Choi SH, Heo JS. Pancreaticoduodenectomy for secondary periampullary cancer following extrahepatic bile duct cancer resection. Ann Surg Treat Res 2014; 87:94-9. [PMID: 25114889 PMCID: PMC4127899 DOI: 10.4174/astr.2014.87.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
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Affiliation(s)
- Dong Hun Kim
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Ho Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wang CL, Ding HY, Dai Y, Xie TT, Li YB, Cheng L, Wang B, Tang RH, Nie WX. Magnetic resonance cholangiopancreatography study of pancreaticobiliary maljunction and pancreaticobiliary diseases. World J Gastroenterol 2014; 20:7005-7010. [PMID: 24944495 PMCID: PMC4051944 DOI: 10.3748/wjg.v20.i22.7005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/08/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To discuss the imaging anatomy about pancreaticobiliary ductal union, occurrence rate of pancreaticobiliary maljunction (PBM) and associated diseases in a Chinese population by using magnetic resonance cholangiopancreatography (MRCP).
METHODS: Data were collected from 694 patients who underwent MRCP from January 2010 to December 2012. Three hundred and ninety-three patients were male and 301 patients were female. The age range was 16-92 years old and the average age was 51.8 years. The recruitment indication of all cases was patients who had clinical symptoms, such as abdominal pain, jaundice, nausea and vomiting, which thus were clinically suspected as relative pancreaticobiliary diseases. All cases were examined by MRCP using single-shot fast spin-echo sequences. In order to obtain MRCP images, the maximum intensity projection was used.
RESULTS: According to the anatomy of pancreaticobiliary ductal union based on our analysis of MRCP images, all cases were classified into normal type and abnormal type according to the position of pancreaticobiliary ductal union. The abnormal type could be further divided into P-B type, B-P type and the duodenum type. By analyzing the incidence of biliary stone and inflammation, pancreatitis, biliary duct tumors and pancreatic tumors between normal and abnormal types, significant differences existed. The abnormal group was more likely to suffer from pancreaticobiliary diseases. Comparing three different types of PBM that were associated with pancreaticobiliary diseases by using Fisher’s method, the result showed that there was no significant difference in the incidence of biliary stones, cholecystitis and pancreatic tumors. The incidence of pancreatitis in B-P type and P-B type was higher than that in duodenum type; the incidence of biliary duct tumor in B-P type was higher than that in P-B type; the incidence of biliary duct tumor in duodenum type was lower than that in P-B type. The incidence of congenital choledochus dilatation in normal type and abnormal type was similar, and there was no significant difference between the two types.
CONCLUSION: Types of PBM are closely related to the occurrence of pancreaticobiliary diseases. MRCP has important clinical value in the early diagnosis and preventive treatment of pancreaticobiliary diseases.
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Goto T, Ajiki T, Murakami S, Matsumoto I, Shinzeki M, Asari S, Mukubou H, Okazaki T, Kido M, Fukumoto T, Ku Y. Rapid progression of second bile duct cancer after resection for extrahepatic bile duct cancer. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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WANG JINGHAN, YU YONG, YAN ZI, HU ZHENLI, LI LINFANG, LI JIANG, JIANG XIAOQING, QIAN QIJUN. Anticancer activity of oncolytic adenoviruses carrying p53 is augmented by 11R in gallbladder cancer cell lines in vitro and in vivo. Oncol Rep 2013; 30:833-41. [DOI: 10.3892/or.2013.2511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/19/2013] [Indexed: 01/10/2023] Open
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Resende V, Roda R, Pedrosa MS. Gallbladder Papillary Neoplasia Associated With Intrahepatic Carcinoma and Pancreaticobiliary Malformation. Gastroenterology Res 2012; 5:245-248. [PMID: 27785217 PMCID: PMC5074823 DOI: 10.4021/gr505e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2012] [Indexed: 12/14/2022] Open
Abstract
Papillary carcinoma is a rare tumor of the gallbladder. Papillary mucinous lesions of the intra- and extra-hepatic biliary tract (BT- IPMN) have been recognized. However the gallbladder is not included, except for the diffuse papillomatosis, where the sequence biliary papillomatosis to papillary carcinoma is proposed. We report a simultaneous case of gallbladder papillary neoplasia and intrahepatic duct carcinoma in situ associated with pancreaticobiliary maljunction (PBM). We proposed that double location, in our case, is more likely explained by a diffuse biliopancreatic tree disease leading to synchronous tumors arising in amenable duct. It was verified absence of continuity between gallbladder and intrahepatic bile duct site of involvement, absence of lymph node metastasis or venous involvement. This case report supports the concept of a proliferative and neoplastic process involving simultaneously the biliary tree and gallbladder associated with PBM.
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Affiliation(s)
- Vivian Resende
- Surgical Department of Minas Gerais Federal University School of Medicine, Belo Horizonte, Brazil
| | - Rodrigo Roda
- Clinical Hospital of Minas Gerais Federal University School of Medicine, Belo Horizonte, Brazil
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Sumiyoshi T, Shima Y, Kozuki A. Synchronous double cancers of the common bile duct. World J Gastroenterol 2012; 18:5982-5. [PMID: 23139617 PMCID: PMC3491608 DOI: 10.3748/wjg.v18.i41.5982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/18/2012] [Accepted: 08/25/2012] [Indexed: 02/06/2023] Open
Abstract
We report an extremely rare case of synchronous double cancers of the common bile duct without pancreaticobiliary maljunction. Only two similar cases have been reported in the English literature. Endoscopic re-trograde cholangiopancreatography showed a tuberous filling defect in the middle and superior parts of the common bile duct, and mild stenosis in the inferior duct. Computed tomography (CT) showed a well enhanced mass in the middle and superior parts of the common bile duct. A single cancer of the middle and superior bile duct was suspected and extra-hepatic bile duct resection was performed. CT eleven months after surgery revealed enhanced inferior bile duct wall and a slightly enhanced tumor within it. Retrospective review of the CT images taken before first surgery showed enhanced inferior bile duct wall without intrabiliary tumor only on the delayed phase. The inferior bile duct tumor was suspected to have originally co-existed with the middle and superior bile duct tumor. Pancreaticoduodenectomy was performed subsequently. Histopathological examination revealed that the middle and superior bile duct tumor was a moderately differentiated tubular adenocarcinoma while the inferior bile duct tumor was a papillary adenocarcinoma. The two tumors were separated and had different histological findings and growth patterns, further suggesting that they were two primary cancers.
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17
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Kumamoto T, Tanaka K, Takeda K, Nojiri K, Mori R, Taniguchi K, Matsuyama R, Ueda M, Sugita M, Ichikawa Y, Nagashima Y, Endo I. Intrahepatic cholangiocarcinoma arising 28 years after excision of a type IV-A congenital choledochal cyst: report of a case. Surg Today 2012; 44:354-8. [PMID: 23090140 PMCID: PMC3898144 DOI: 10.1007/s00595-012-0387-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
This report presents a rare case of intrahepatic cholangiocarcinoma (IHCC) arising 28 years after excision of a type IV-A congenital choledochal cyst. The patient underwent excision of a congenital choledochal cyst (Todani’s type IV-A) at 12 years of age, with Roux-en-Y hepaticojejunostomy reconstruction. She received a pancreaticoduodenectomy (PD) using the modified Child method for an infection of a residual congenital choledochal cyst in the pancreatic head at the age of 18. She was referred to this department with a liver tumor 22 years later. Left hemihepatectomy with left-side caudate lobectomy was performed and the tumor was pathologically diagnosed to be IHCC. The cause of the current carcinogenesis was presumed to be reflux of pancreatic juice into the residual intrahepatic bile duct during surgery. This case suggests that a careful long-term follow-up is important for patients with congenital choledochal cysts, even if a separation-operation was performed at a young age, and especially after PD.
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Affiliation(s)
- Takafumi Kumamoto
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan,
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Beltrán MA. Current knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction. Int J Surg 2012; 10:190-3. [PMID: 22361306 DOI: 10.1016/j.ijsu.2012.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 02/07/2023]
Abstract
Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and their pathologic implications has experienced tremendous progress during the last few years. This article reviews the current knowledge on this condition and its pathological implications on gallbladder diseases. Many publications with different levels of evidence were found supporting biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction. Also, there are many publications supporting the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and sphincter of Oddi dysfunction as the most plausible cause of this condition. Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and their clinical significance, the current evidence does not fully support what has been suggested. The reflux of pancreatic enzymes into the bile tract and gallbladder is a fascinating subject of study which is open to active research. The final demonstration of the pathophysiology and consequences of PBR in NPBL and support by evidence level type I would constitute a major breakthrough in the understanding and eventually in the treatment of gallbladder diseases.
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Affiliation(s)
- Marcelo A Beltrán
- Department of Surgery, Hospital de La Serena, P.O. Box 912, La Serena, IV Región, Chile.
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Kobayashi S, Konishi M, Kato Y, Gotohda N, Takahashi S, Kinoshita T, Kinoshita T, Kojima M. Surgical outcomes of multicentric adenocarcinomas of the biliary tract. Jpn J Clin Oncol 2011; 41:1079-85. [PMID: 21875937 DOI: 10.1093/jjco/hyr103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In comparison to single biliary cancers, distinct features of biliary multicentric adenocarcinomas are not yet clear. METHODS From July 1992 to July 2009, 393 patients underwent surgery for cancers of the biliary tract at the National Cancer Center Hospital East, Kashiwa, Japan. Clinicopathological characteristics and surgical outcomes of multicentric biliary adenocarcinoma were compared with those of single cancers. RESULTS During the period, 10 cases (2.5%) with multicentric cancer (6 synchronous and 4 metachronous cancers) were found among 393 cases of biliary cancer. Pathologically, compared with single cancers, multicentric adenocarcinomas were more likely to be early cancers and to be papillary carcinomas with both superficial epithelial tumor spread and extensive dysplastic epithelium, but were less likely to have lymph node metastases (P < 0.01). The proportion of multicentric cancers among early papillary cancers was high (9/24, 37.5%). Clinically, no recurrences were detected in lymph nodes, peritoneum or distant organs, but one recurrence in the remnant bile duct. Only one patient died from cancer progression. The overall survival of patients with multicentric adenocarcinomas was statistically the same as that of single cancers (median survival: 69 vs. 30 months, P = 0.47). CONCLUSIONS Multicentric adenocarcinomas of the biliary tract have distinct features compared with single cancers.
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Affiliation(s)
- Shin Kobayashi
- Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Beltrán MA. Pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction: Pathologic implications. World J Gastroenterol 2011; 17:953-62. [PMID: 21448346 PMCID: PMC3057156 DOI: 10.3748/wjg.v17.i8.953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 12/03/2010] [Accepted: 12/10/2010] [Indexed: 02/06/2023] Open
Abstract
Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years. This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases. The following aspects were defined appropriate for discussion: (1) Evidence of carcinogenesis associated with pancreaticobiliary reflux; (2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction; and (3) Evidence of sphincter of Oddi (SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction. The articles reviewed were selected and classified according to five levels of evidence: LevelI, meta-analysis double-blind randomized clinical trials, Level II, cohort non-blinded studies and non-randomized clinical trials, Level III, good quality case-control studies and non-randomized cohort studies, Level IV, case series and poor quality case-control studies, and Level V, case report articles and experts’ opinion. Evidence levels II, III, IV and V were found to support biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction. The same levels of evidence were found to support the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and SO dysfunction as the most plausible cause of this condition. Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance, the current evidence does not fully support what has been suggested. Studies with evidence level I have not been undertaken. This is a fascinating subject of study, and if finally supported by evidence level I, the importance of this condition will constitute a major breakthrough in biliary pathology.
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